Permit '' . 4y „ CITY OF TIGARD PLUMBING PERMIT
a''.. COMMUNITY DEVELOPMENT Permit #: PLM2013 -00014
Date Issued: 01/09/2013
TIGARD. 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S103DCO3100
Jurisdiction: Tigard
Site address: 11260 SW VIEWMOUNT CT
Project: Perkin Subdivision: VIEWMOUNT Lot: 19
Project Description: Replacement of 70' of sanitary service line
Contractor: S & S SEARS INC Owner: PERKIN, BARBARA J & HOWARD P
PO BOX 446 11260 SW VIEW MOUNT CT
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503 - 650 -8200 PHONE:
FAX: 5023 - 650 -8203
FEES
Quantity Description Date Amount
70 If Sewer Service 01/09/2013 $62 54
Specifics: 1 12% State Surcharge - 01/09/2013 $8 70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 01/09/2013 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o ' suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center Those ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir t questions to OUNC • ing 5r ' 32 1987 or 1.800 332.2344
i
Is ued By: / Permittee Signature:
— / Call 503.639.4175 by 7:00 a.m. for the next available inspection date. _. ,4,,.....„. .
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/ r
Plumbing Permit Applicati
Building Fixtures ECEIVED FOR OFFICE USE ONLY
City of Tigard Received /
11 13125 SW Hall Blvd , Tigard,OR 9722JAN 0 9 2013 D ate/By i Q i 6 kj Permit No a/k(s ��y
Plan Review
Phone. 503.718 2439 Fax 503.598 1960 Date/By. Other Permit No
I' I G A R D Inspection Line' 503.639.4175 CITY OF TIGARD Date Ready/By Juris El See Page 2 for
Internet: www tigard- or.gov BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea I Total
N Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
W I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: - Job site address: 1 r (9 � j � I/ ` ', � a atch basin or area drain 18.76
/ � ` l V) , Drywell, leach line, or trench drain 18.76
City /State /ZIP: T� l /4 9 7 7 _ Z 3
/ Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) 7 e , Page 2
Storm sewer (no. linear ft.. ) ` Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF W I RK Backwater valve 12.51
Clothes washer 25.02
• ./ . ._' (1 m E . ' IF ...r ALA Dishwasher 25.02
Drinking fountain 25.02
/ Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25 02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25 02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25 02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25 02
CONTRACTOR Water closet 25.02
Water heater 37.52
1
Business name: G �'
J 5 � __44 h t /ls /4, (J _ Rater piping/DWV 56.29
Address: rO fj( 4 6 C.. Other: 25.02
City /State /ZIP: �, / L�lt� r Subtotal
Phone: ( )6, 57)_ 8 7� (/ r Fax: ( ) 6a. -8 Zc3 Minimum permit fee: $72.50 Zg-
CCB Lic.: / Plumbi 1 Lic. no.: � ` Plan review (25% of permit fee)
I 0_ AI State surcharge (12% of permit fee) $' . 70
Authorized signature: // _ TOTAL PERMIT FEE 151, go
Print name: ,,,v,k P - PJA 7..... Date: / — --- j 3 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tn - County Building Industry Service Board
I \ Building\Permits\PLMU- PermitApp doe 10/01/09 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l' 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233 20
Sewer - 1st 100' 62.54
7,201 and greater $327 54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1 00 to $5,000.00 Minimum fee $72.50
Storm & Ram Drain - each additional 100' 37.52 $5,001.00 to $10,000 00 $72 50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qt'. Fee (ea) Total each additional $100.00 or fraction thereof, to
h and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000 00 $148.50 for the first $10,000.00 and $1 54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge — 1/2 hour) and including $25,000 00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000 00 $379 50 for the first $25,000.00 and $1 45 for
hours (minimum charge — 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742 00 for the first $50,000.00 and $1.20 for
(minimum charge — 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower
engineer.
- Jacuzzi/Whirlpool
Car Wash. Each Stall ❑ New exterior plumbing site utilities for any complex structure
Dave tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower. -Gang
-Stall
Sink. - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures.
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